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Lithium

Generic Name: lithium (LITH ee um)
Brand Names: Lithobid, Eskalith, Lithonate, Lithotabs

Medically reviewed on July 4, 2018

What is Lithium?

Lithium affects the flow of sodium through nerve and muscle cells in the body. Sodium affects excitation or mania.

Lithium is used to treat the manic episodes of bipolar disorder (manic depression). Manic symptoms include hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression, and anger.

Lithium also helps to prevent or lessen the intensity of manic episodes.

Important Information

Do not use lithium without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Call your doctor at once if you have any early signs of lithium toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Drink extra fluids to keep from getting dehydrated while you are taking this medication.

Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Before taking this medicine

You should not use lithium if you are allergic to it.

Tell your doctor if you have ever had:

  • an abnormal electrocardiograph or ECG (sometimes called an EKG);

  • fainting spells;

  • a family history of death before age 45;

  • kidney disease;

  • heart disease;

  • a debilitating illness;

  • a thyroid disorder;

  • low levels of sodium in your blood; or

  • if you are dehydrated.

Some medicines can interact with lithium and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breast-feed while using this medicine.

Lithium is not approved for use by anyone younger than 12 years old.

How should I take lithium?

Take lithium exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Never use lithium in larger amounts, or for longer than prescribed. An overdose can occur if you take only slightly more than a recommended dose.

Swallow the tablet whole and do not crush, chew, or break it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Taking lithium can make it easier for you to become dehydrated, especially if you have any vomiting or diarrhea, if you are outdoors in the sun, or if you exercise vigorously or sweat more than usual. Dehydration can increase some of the side effects of lithium.

Call your doctor if you are sick with a fever and vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking lithium, which may affect your dose needs. Do not change your dose or medication schedule without your doctor's advice.

Drink extra fluids each day to prevent dehydration.

It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not begin to improve after 1 week of treatment.

You may need frequent blood tests.

If you need surgery, tell the surgeon ahead of time that you are using lithium.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Lithium dosing information

Usual Adult Dose of Lithium for Mania:

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Adult Dose of Lithium for Bipolar Disorder:

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose of Lithium for Mania:

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).
-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose of Lithium for Bipolar Disorder:

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).
-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Stop taking lithium and seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Early signs of lithium toxicity include: vomiting, diarrhea, tremors, loss of balance or coordination, drowsiness, or muscle weakness.

What should I avoid while taking lithium?

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink.

Do not change the amount of salt you consume in your diet. Changing your salt intake could change the amount of lithium in your blood.

Lithium side effects

Get emergency medical help if you have signs of an allergic reaction to lithium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • irregular heartbeats, shortness of breath;

  • fever, increased thirst or urination;

  • weakness, dizziness or spinning sensation;

  • confusion, memory problems, hallucinations;

  • uncontrolled muscle movements, slurred speech;

  • loss of bowel or bladder control;

  • a seizure (blackout or convulsions);

  • dehydration symptoms - feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or

  • increased pressure inside the skull - severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common lithium side effects may include:

  • drowsiness;

  • tremors in your hands;

  • dry mouth, increased thirst or urination;

  • nausea, vomiting, loss of appetite, stomach pain;

  • changes in your skin or hair;

  • cold feeling or discoloration in your fingers or toes;

  • feeling uneasy; or

  • impotence, loss of interest in sex.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect lithium?

Tell your doctor about all your current medicines. Many drugs can interact with lithium, especially:

This list is not complete and many other drugs may interact with lithium. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use lithium only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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